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The mobile phone as a personal health system for global health. Health is a state of physical, mental and social well-being not only the absence of infirmity and disease WHO 1948 - PowerPoint PPT Presentation
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• Health is a state of physical, mental and social well-being not only the absence of infirmity and disease WHO 1948
• Understanding health not as the absence of disease, but rather as the process by which individuals maintain their sense of coherence (resilience) and ability to function well in the face of changes in themselves and their environment (from Aaron Antononovsky 1987)
The mobile phone as a personal health system for global health
Holism
Holistic is an approach to practice that goes beyond the traditional medical model to consider the patient’s mind, body, emotions, and spirit in the context of his or her family’s beliefs, values, culture, and community
Happiness score - SWEMWBS • Item 1 – I've been feeling optimistic about the future• Item 2 – I've been feeling useful• Item 3 – I've been feeling relaxed• Item 6 – I've been dealing with problems well• Item 7 – I've been thinking clearly• Item 9 – I've been feeling close to other people• Item 11 – I've been able to make up my own mind about things
GNH not GNP is the social wellbeing indicator
How should global wellbeing be measured?
USA spends >15% of GNP and is no 38 in life expectancy
Happiness and health
• The effect of happiness on longevity in healthy populations is remarkably strong.
• The size of the effect is comparable to that of smoking or not.
Thai Integrative care cycle
ANS-HRV
Modern biomedicine
The core of a scientific Wellness Program
mindfulness
activitynutrition
health
Each of these affect ANS function in a measurable individual way, and collectively balanced can restore optimal resilience and health
ICT
Some of the actors required for social wellbeing on which the health of the nation depends
The challenge
• The need: a fusion of East and Western medicine
• The science behind the change
• The solution - from Technostress to Technohealth
• The opportunity for 21st century global health – a national simulator for inclusive personalized health
mHealth Alliance Gaps and barriers – a policy white paper 2010
• Treatment Compliance (SMS) - 43• Data Collection and Disease Surveillance – few studies 34• Health Information Systems (no EMR) and Point-of-Care
Support - 30• Health Promotion and Disease Prevention - 25• Emergency Medical Response – 37
From The WestImaging Neurosciences‘Omics’ SciencesSystems Biologypsychobiology
From The EastEnergy MedicineMeditation &Mindfulness, breathing
Autonomic nervous system
Personalizing public health care
Note the role of mind and breathing
24 hour HRV
The relationship between ANS- HRV and lifestyle, disease risk, and disease progression – or regression- follows below
Blue tooth
5 day recording
HRV,
3D motion and position
Blue tooth
24 hour recording
Respiration,
HRV,
3 D motion and position
temperature
Three examples of wearable wireless biomonitors
HRV3D emotion (Mega electronics)
24 hour heart rate recorder
Using wireless biomonitoring locally and remotely
A digital image of the mind & body from a heart beat signal
Laboratory accuracy from a consumer device
Conventional way of analyzing and reporting ANS- HRV – reducing the value of a personal dynamic biomarker
Averaged over time and grouped
Slow deep breathing (6/min) is a test of ANS condition and a biofeedback ‘tool’ for tracking response to self-improvement, or decline. ANS-HRV function can be reptrained
HRV-RSA – personal biomarkerDiabetes
HRV power related to severity of Coronary Arterial Disease
Progressive loss of HRV with increasing severity of CAD
1
2 3
200
0
The autonomic nervous system (now easily measured) is affected by chronic stress and most diseases – loss of heart rate variation predicts the risk for illness and premature death– but is ‘reversable’ by improved lifestyle
8 a.m. 8 a.m.
Healthy
Obese
HeartDiseasediabetes HypertensionStrokeMentalcancer
l
BreathingHeart rate
sleep
The ‘social’ & lifestyle stress pathway to illness & death
Social wellbeing
Mental wellbeing ANS-HRV & Immune resilience social determinants
Physical wellbeing
Mental stress social stress
Depression
ANS-HRV & immune depression
diet Metabolic stress
activity
smoking
ANS-HRV & immune dysfunction drugs
Cellular & vascular injury
Organ specific diseases cardiovascular
mental disorder metabolic syndrome diabetes arrhythmic - infective death
cancer other ANS-HRV – immune failure
Death
Phenotype
Genotype
The link to infection and critical care medicine
24 hours
A healthy 24 hour heart rhythm pattern is a Nepalese Buddhist Tulku
chanting – meditation - sleep Sala dance
Critical brain heart rhythms from health to stress
Healthy
stress
5 minutes
Respiratory rhythm (RSA) exists in the heart rate rhythm (15 per minute) at rest during deep sleep in healthy people – seen in the top trace and expanded in the window on the right. This shows good relaxation and autonomic nervous system (ANS) balance – resilience. This same oscillation (RSA) is increased, slowed & synchronised when breathing is slowed to 6 breaths per minute during pranayama breathing. Repeated daily this practice restores or improves heart rate variability (biorhythms), relaxation and wellbeing.
Deep sleep
pranayama breathing
Camel 1 pranayama compared with resperate at 6 breaths/minute
20 minutes
The oscillation in heart rate (top blue line) with pranayama breathing at 6 breaths/minute is much greater than breathing at 6 breaths a minute with resperate * (an FDA approved breath training device for treating hypertension)
Coordinated slow breathing and movement increases the psychophysiological benefit
measure Value - range
PeTCO2 mm Hg 29 - 43
Vt (L/min) 4.6 -8.2
Abdomen % 20 - 85
VT (L) 0.25 - 0.60
Te (sec) 1.5 – 5.0
Ti (sec) 1.2 – 2.2
Frequency (min) 10 - 21
Individuality of breathing pattern in healthy man (n = 41)
Individuality of breathing pattern remains during sleep, over years in adult life, genetic (twins). Future personalized care will factor in cardiorespiratory as well as behavioural differences
Heart failure with periodic breathing ‘controlled’ by ‘yoga’ breathing
SaO2
resp
HRV
Resp vol
B
10 minutes
6 breaths / minute
Meditation and exercises (e.g. Yoga, Thai traditional stretch, Tai Chi ) improve physiological synchrony and well being – heart rate and breathing coherence are particularly important.
1 hour
10 minutesheartmath
Breathing entrained for maximum RSA in heart rate
6 breaths a minute
Some benefits of slow breathing
• increase 'resting' HRV (RSA) and reduce sympathetic (stress) activity
• increase baroreceptor response • reduce blood pressure (in hypertensives) • improve immune responses • increase expiratory control • reduce breathing frequency • reduce heart rate • increase thoracic diameter • increase oxygenation and exercise performance in heart failure • increase brain blood flow (during slow breathing) • increase EEG theta activity • increase a feeling of wellbeing and relaxation
Personalized exercise – getting it right
Some people get no metabolic benefit from endurance training while others get metabolic value from resistance training – they are genetically different
Phasic exercise training
Comparing endurance training with phasic exercise training
Training recovery equally with exertion (phasically) improves muscle and cardiovascular function – metabolic recovery. Qi Gong and Tai Chi achieve similar benefits
GETTING MORE FROM LESS (exercise)
This is a 30 minute recording from an experienced practitioner demonstrating 8 QiGong standing movements performed at 6 per minute with co-ordinated slow diaphragmatic breathing. The precision of each movement can be seen with the heart rate oscillating at the same rhythm. This shows optimal relaxation – mental and physical during exercise
Brain imaging techniques show distinct forebrain links of the ANS to cardiac sympathetic activity, emotion and cognition, with laterality related to behavioural responses. Meditation and breathing alter brain structure and function
Mobile HRV is now a sophisticated specialist clinical test and on-line consumer self-care tool
Personalised health status – diagnostic tests and serial assessment
Range of on - and off-line training and biofeedback toolssupervised and self managed
effective breathing
effective relaxation
effective exercise
effective diet
effective ???
Networked across region – test site
Mobile telemonitoring service -
Institute for Alternative Futures
Mobile wireless biomonitors + knowledge = n-of-1 R&D
Out-moded by th
e mPHS = n-of-1
study
NB n-of-1 study was devised in 1988 for designing RCTs where patient behaviour was a prominent factor! – seldom used
Elements of a personal health system
• Wearable wireless biosensors – ‘click-clunk’
• Personal psychophysiology – 24-hour HRV-3D activity; RSSMD values *
• Lifestyle diary – HRV-3D related to life events (sleep, relaxation, stress, exercise etc)
• mICT (mobile – tablet)
• Cloud service – database – on- and off-line service
• Remote testing – tilt test; valsalva; fixed rate & slow diaphragm breathing; balancing; stress & emotion testing
• Biofeedback – direct (personal data) & indirect (program guides)
• Personal Health Record and clinical guidelines
• EDUCATION - User friendly results and display; incentive, reward and fun; ‘games’
* hierarchical levels of investigation and therapy
mICT
mPHS
Integrated Health Services to include Health Promotion, Disease Prevention - SDHI
Ethical Biomedical
R&D - EBRD SDHI - PsyPhys knowledge base
Civic health
HiAP
SDHI
Public health
Education
3rd parties & Commercial
ICT
Biomedicine is fragmented & misaligned
Developing mPHS for integrative careLab on chip inclusive interfaces 3rd generation sensors intelligence infuse with EBRD
Level 3
Level 2
Level 1
Incremental levels of ICWS biomonitoring for wellbeing, risk reduction, early diagnosis, disease management and research
1,500 x PHS = 24-hour HRV/activity belts EPHR
Investigations may pass between level 1, 2 or 3 for diagnosis or research. Serial ANS-HRV24 contextualized measurement is the foundation of all personal programs
ALL CITIZENS - annual, monthly, more – wellbeing self- assessment
Mind-body re-training/ biofeedback
Specific mind-body re-hab training/ biofeedback Diagnosis and rehab
High-level community investigation and research
- shared-care patients
200 x PHS = 24 hour HRV, activity, breathing with oximetry, BP as required. Portable scanning
TeleMed clinics
Ambulatory and polyclinic investigations sleep disorders; EEG; portable scanning; other technologies
TeleMed clinics